INJURIES OF THE HAND AND FOREARM—Treatment of Damaged Soft Tissues

Successful primary repair of soft tissue injuries of the hand and forearm holds the ultimate disability to a minimum. The kinds of trauma and the resultant soft tissue damage may be classified. Attention to details and technique in carrying out the primary reparative operation on the injured hand largely obviates a crippling deformity or the need for much reconstruction later.     

CRUSHING INJURY OF THE HAND—Prevention of Ischemic Contracture

Crushing injury of the hand usually causes “explosive” damage. Subsequent swelling of the palmar structures further impairs venous outflow, and hemorrhage into structural spaces increases the pressure. The arterial system and the large dorsal veins, however, are seldom obstructed and provide adequate circulation unless hampered by improper bandaging. A bandage that compresses the dorsal veins causes back-pressure, which increases the swelling further and brings about ischemia. Swelling and pain cause the patient to restrict exercise of the injured hand, which permits contractures to develop.The author has averted this sequence in more than 100 cases by preserving integrity of veins during debridement, arresting hemorrhage, bandaging the hand with compression dressings in functional flexion, and reducing swelling with hyaluronidase. In these cases, on removal of bandages in 24 hours, swelling was reduced and continued to diminish. All patients exercised the hand at this time without discomfort and only a few required aspirin for pain.     

IMPALEMENT INJURIES OF THE HAND—Repair of Damage from Broken Bean Poles

A not uncommon injury of the hands among agricultural workers is impalement on the sharp ends of tomato-vine or bean-vine stakes that shatter as they are being driven. Careful debridement and tetanus prophylaxis are important in treatment. There are several simple precautions and changes in work methods that could greatly reduce the incidence of such injuries.